To the best of our knowledge, this is the first study conducted in a large population of university students, in France, with its main focus on the relationship between perceived stress, substance use and related disorders.
Perceived stress among university students is gender related. Female students are more exposed to stress associated with risk of cyber addiction, disorders related to alcohol use, eating disorders, and regular smoking than their male counterparts. Stress levels in our study were higher among female students than male students. Whilst some previous studies found similar results to ours , others reported that gender was not a risk factor for stress .
Our results also revealed a high prevalence of students with risk of eating disorder, since almost a quarter of our population had positive SCOFF score. Previously, Costarelli reported similar prevalence . Eating disorders are the main behaviors associated with perceived stress and increased risk in each stress quartile.
Significant results were found for alcohol use and perceived stress. Whereas stress scores were positively associated with some alcohol disorders, they were not associated with excess alcohol use (drunkenness and binge drinking). It is important to highlight that the rate of students with alcohol use disorders (positive ADOSPA test) increased with level of perceived stress, even after adjustment. These results suggest that high stress levels lead students, not only to hazardous drinking patterns, such as dependence or getting high, but also to harmful behaviors towards alcohol, regardless of quantity or frequency of consumption.
Cigarette smoking in students is often described as social smoking and most students smoke for reasons other than stress relief, especially to facilitate social interactions, to avoid feeling alone, and behaving as a member of a group . During stressful events, cigarettes not only help stress management, but also express non-verbally to others that the student is stressed . Student tobacco consumption in response to stress can be associated with increased risk of nicotine dependence in later life.
Risk of cyber addiction was 27.5%, which might seem high but not all students become cyberaddicted. The prevalence of internet addiction disorder in an Italian student population was 5% and 1% respectively for moderate and serious users . While studies have indicated that internet addicts are mostly young males with introverted personalities, the rate is currently rising in the female population . Our study revealed a positive trend towards increased stress levels in students at risk of cyber addiction. Excessive behavior in internet addicts may serve as a stress coping strategy, albeit inadequate. The Internet may also be used as a forum for expanding social networks and consequently improving the chance of meaningful relationships, self-confidence, social abilities, and social support. Those using internet primarily for online chatting believed that it was psychologically beneficial. They also believed that frequent internet users were lonely and that the Internet could be addictive. “Chat” users, who are socially fearful, may be using the Internet as a form of low-risk social approach and an opportunity to rehearse social behavior and communication skills, which may help them improve interactions in face-to-face social environments . Nevertheless, addicts may use the internet for extended periods, isolating themselves from other forms of social contact, and focussing almost entirely on the Internet rather than broader life events .
Physical activity is also considered to have beneficial effects on mental health and stress coping capacity. Indeed, exercise as a moderator of stress levels was previously investigated in  university student populations . Moreover, these results suggested an appraisal of physical activities in order to reduce psychological distress among students.
Although curriculum was not a risk factor for stress in our study, previous studies have shown that medical students are highly stressed and have proposed coping strategies . To our knowledge, three recent nationally-representative surveys have studied the prevalence of substance use among young adults in France and allow comparisons [33, 51, 52]. Our results were similar to those reported by Riou Franca et al., for tobacco and cannabis, and Melchior et al. for alcohol, binge drinking and polydrug use. Common definitions and criteria concerning substance use need to be validated and used internationally to allow comparisons.
There is an attitude among students of turning a blind eye towards existing stress, which is a serious problem and may be a harbinger of serious mental and psychosocial problems. Based on the findings from our research, it is important for future prevention and intervention efforts to consider social setting and heightened stress among students as potential risk factors for engaging in risk behaviors.
Baker et al. found evidence of moderate rates of Internet use in the healthcare sector among adult internet users, as well as moderate effects of the Internet on the knowledge of users. Internet is clearly an important tool with the potential to improve information dissemination. The Internet is a means of transmitting information on health. The rise in popularity and possibilities of the Internet has led to a revolution in the provision of health-related information and treatment. While the health sector has primarily employed the Internet as a psycho-educational portal, advances in interactive technology have increased the potential of the medium to deliver targeted health interventions and other behavior change programs [49, 53]. An interactive website: MyStudentBody.com offers a brief, tailored intervention to help heavy-drinking college students reduce their alcohol use. Acquiring and improving knowledge on student populations is a crucial factor in the development of health promotion programs in order to meet students’ needs and to help them cope. Enhanced understanding of the personality profile of university students can be helpful in academic and career choices. Developing efficient coping strategies in students and improving academic environments could also contribute to preventing the potential deleterious consequences of stress .
Our study has certain limitations in as much as students were invited to participate in the study, and therefore the sample was not randomized. However, since several study disciplines were represented, the sample might be considered as representative of the student population. In addition, this cross-sectional study was based on self-reported information provided by students and collected throughout the year with very few answers returned during the stressful examination period. There is also some potential for reporting bias which may have occurred because of the respondents' interpretation of the question or desire to report their emotions in a certain way or simply due to inaccuracies in responses. Despite these limitations, we consider that our study provides important new information on the multiple health risks related to stress in students.